A 47-year-old woman was diagnosed with dural carotid cavernous fistula (CCF) in her right eye (RE). Scans of the choroid using Spectralis optic coherence tomography (OCT) demonstrated significant asymmetry in subfoveal choroidal thickness (RE 451 μm, left eye (LE) 367 μm). This asymmetry disappeared after the fistula was embolizated through the ophthalmic artery (RE 341 μm; LE 340 μm). This case suggests that OCT should be considered as an ancillary test in the diagnosis of CCF.

PurposeTo determine changes in lamina cribrosa (LC) and prelaminar tissue in patients with unilateral non‐arteritic anterior ischemic optic neurophaty (NAION) using enhanced depth imaging (EDI) spectral domain optical coherence tomography (SD‐OCT).MethodsSeventeen eyes of 17 patients with NAION were prospectively studied. SD‐OCT scans using EDI technology were obtained at the acute episode and at two and six months after the ischemic event. The OCT device was set to image a 15x10 degree vertical rectangle centered on the optic disc. The scan in LC was seen clearliest was selected for analysis. The vertical distances from three equidistant points on the reference line (Bruch's membrane opening‐BMO) to the anterior prelaminar tissue surface, and to the anterior and posterior surfaces of the LC were measured.ResultsAt diagnosis, mean prelaminar tissue was significantly thicker and anterior LC surface more posteriorly placed in NAION eyes than in non‐involved eyes. During the follow‐up, in NAION eyes there was a significant prelaminar thinning and an anterior LCreversal (P = 0.001 and P = 0.002 at 2 and 6 months respectively). BMO significantly reduced during follow‐up (P = 0.008 and P = 0.034 at 2 and 6 months respectively). Both prelaminar tissue thickness and BMO changes correlated with retinal nerve fiber layer thickness measurements.ConclusionsOHN is a dynamic structure that undergoes biomechanical changes in eyes suffering NAION. A significant prelaminar tissue thickening and posterior lamina cribrosa displacement occurred during the acute ischemic optic neuropathy, that reverse as the edema resolves.

PurposeTo evaluate corneal and optic nerve head (ONH) biomechanical changes following nonpenetrating deep sclerectomy (DS).MethodsForty‐nine eyes undergoing DS were prospectively studied. Changes in corneal hysteresis (CH) and corneal resistance factor (CRF) using the Ocular Response Analyzer, as well as changes in prelaminar thickness, cupping and lamina cribrosa (LC) position using EDI technology before surgery and 3 months postoperatively were obtained. Simple and multiple linear regression models were used to determine predictors of ONH changes including age, corneal central thickness (CCT) and axial length (AL).ResultsMean corneal compensated IOP significantly decreased by 27.9% (P < 0.001). Mean CH increased and CRF decreased by 18.4% and 10.1% respectively (P < 0.001) and both were significantly correlated with IOP reduction (P < 0.001). There was a significant reversal of ONH cupping mainly due to a prelaminar tissue thickening (P < 0.001). Mean preoperative AL correlated with the preoperative LC thickness (−0.459, P = 0.012) and a further anterior displacement of LC postoperatively (0.377, P = 0.044). A significant association was found between ONH cupping reversal and both preoperative IOP (P = 0.046) and preoperative CRF (P = 0.002).ConclusionsCH increased and CRF decreased significantly 3 months after NPDS and these changes correlated with IOP reduction. A significant cupping reversal mainly due to changes in prelaminar tissue thickness was observed. The magnitude of IOP reduction was the most significant factor in both corneal and ONH biomechanical changes.

PurposeTo determine changes in lamina cribrosa (LC) and prelaminar tissue in patients with unilateral non‐arteritic anterior ischemic optic neurophaty (NAION) using enhanced depth imaging (EDI) spectral domain optical coherence tomography (SD‐OCT).MethodsSeventeen eyes of 17 patients with NAION were prospectively studied. SD‐OCT scans using EDI technology were obtained at the acute episode and at 2 and 6 months after the ischemic event. The OCT device was set to image a 15 × 10° vertical rectangle centered on the optic disc. The scan in LC was seen clearliest was selected for analysis. The vertical distances from three equidistant points on the reference line (Bruch's membrane opening‐BMO) to the anterior prelaminar tissue surface, and to the anterior and posterior surfaces of the LC were measured.ResultsAt diagnosis, mean prelaminar tissue was significantly thicker and anterior LC surface more posteriorly placed in NAION eyes than in non‐involved eyes. During the follow‐up, in NAION eyes there was a significant prelaminar thinning and an anterior LCreversal (P = 0.001 and P = 0.002 at 2 and 6 months respectively). BMO significantly reduced during follow‐up (P = 0.008 and P = 0.034 at 2 and 6 months respectively). Both prelaminar tissue thickness and BMO changes correlated with retinal nerve fiber layer thickness measurements.ConclusionsOHN is a dynamic structure that undergoes biomechanical changes in eyes suffering NAION. A significant prelaminar tissue thickening and posterior lamina cribrosa displacement occurred during the acute ischemic optic neuropathy, that reverse as the edema resolves.